supply chain management assignment 1 kothandaraman rengarajan

8/7/2019 Supply Chain Management Assignment 1 Kothandaraman Rengarajan

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EPGIDB VSAT 2010-2011 Supply Chain Management

Assignment 1

Improving Pharmacy Supply-Chain Management in the Operating

Room

Background:

As expenses rise and payment declines, healthcare organizations are challenged to find innovative waysto improve services cost-effectively without compromising quality Anesthesia services are ideally suited

for cost containment. Expenditures directly controlled by anesthesia providers represent approximately 4

percent of total U.S. healthcare costs.

Healthcare organizations should analyze their processes for providing pharmacy services and determine

where those processes can be improved to enhance care delivery cost-effectively.

Issues:

Deaconess Hospital, a not-for-profit, 389-bed, acute care facility in Evansville, Indiana, like hospitals

nationwide, had experienced reduced payment and increased drug expense related to anesthesia care. In

addition, the growth of ambulatory surgery centers was challenging the hospital to remain competitive

and operate efficiently in an environment of decreasing volume and limited financial resources.

One area of potential improvement was related to the provision of pharmacy services to the operating

room (OR). Traditionally, involvement of the hospital's pharmacy services in drug distribution in the OR

had been limited to floor stock replacement with little or no accountability for or control of the drugs or

the charges.

The hospital endured lost charges due to physicians' illegible handwriting, pharmacy services' lack of

knowledge about physicians' orders, variations in charging techniques, and charging omissions. Because

the pharmacy department was located far from the OR, delays in drug therapy occurred.

The OR nurses were responsible for the preparation and set-up of medications for each surgery, which

added to nursing labor expense and took nurses away from direct patient-care activities. The storage and

inventory system in the OR encouraged overstocking, resulting in excess inventory and potential waste

due to expiration of medications.

Stakeholders for the SCM research

- The team included nurses, pharmacists, physicians, and financial, technical, performance

improvement, and clerical staff to ensure that all areas that could be affected by process changes had

input.

- Key supporters of the project included managers of the OR and pharmacy, quality assurance

personnel, financial analysts, the chief of anesthesia, and the hospital COO.

Data collection

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Assignment 1

It included time studies, flowcharting, financial charge audits, benchmarking, and literature analysis. The

team also conducted a site visit at two facilities that had a successful process in place for providing

pharmacy services to the OR.

SCM improvement- Satellite pharmacy services:

Significant improvement initiative was the establishment of a satellite pharmacy service for the OR. After

considerable evaluation of various drug-distribution systems, the team determined that the surgery

satellite concept would provide the best solution for the problems identified.

- The satellite service provides a pharmacist and technical pharmaceutical personnel in the surgical

services department from 6:00 AM to 4:30 PM weekdays.

- An automated dispensing machine serves as a back-up system when the satellite is closed.

- The machine stores commonly ordered medications and provides an on-line mechanism for

accurate medication charging and drug-acquisition control.

- The charge nurse has access to the satellite for anesthesia trays and medications that are notavailable from the dispensing machine.

Implementation of the satellite also resulted in the following improvements:

* Standard anesthesia trays reflected a standard drug formulary for anesthesia products;

* Anesthesiologists and pharmacists now are held accountable for controlled-substance acquisition,

disposition, and record-keeping;

* Floor stock was eliminated, minimizing waste;

* Bar-code technology was implemented for charging;

* Intravenous medications are prepared under an aseptic laminar-flow hood;

*The pharmacist provides the department of anesthesia with monthly education programs and information

regarding drug costs and waste reduction;

* Medications are delivered directly to the surgeon or anesthesiologist in the OR suite by pharmacy

personnel; and

* The pharmacist provides drug information to medical personnel immediately upon dispensing drugs.

Results:

The satellite pharmacy service has had a positive impact on the hospital. Before implementation, less than

50 percent of surgeries began on time. The percentage of on-time surgery starts rose to 64 percent in

November 1997 and 69 percent in July 1998.

The response time for medication delivery to a physician in the OR dropped from 15 minutes to less than

2 minutes immediately after implementation of the satellite pharmacy service. Improvements in the

narcotic-distribution process resulted in improved narcotic control, which had been recommended by the



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Assignment 1

State Board of Health, and assurance of compliance with new standards being established at that time by

the Joint Commission on Accreditation of Healthcare Organizations.


supply chain management assignment 1 kothandaraman rengarajan

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